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  1. Conflicting rights

I am a teacher in a special school and I dread going into work each morning because I have a well-developed, physically strong 14-year-old boy in my class who will punch and kick staff if he does not get his own way. Already two classroom assistants are out on extended sick leave from injuries they received when trying to safely manage this boy’s outbursts. The parents blame the staff and say it is our job to manage him. I think he may have a psychiatric problem, however the parents will not allow the psychiatrist to prescribe anything. Please can you help? I am desperate.

A.

Unfortunately the classroom behaviour you describe is not that uncommon and may present the school with a complex ethical dilemma. On the one hand, each child is entitled to receive an education; however, school personnel also have a right to work in a safe environment. Ultimately the decision to be taken needs to be whatever is in the best interest of the pupil. This will require that he be provided with an appropriate environment in which he is allowed to learn. I would suggest that an emergency meeting involving parents, school personnel and members of the multidisciplinary team be convened to examine crisis intervention techniques, in order to ensure the safety of all concerned and to investigate whether the present setting is the most suitable for this boy. The crisis intervention techniques are likely to include methods of antecedent control, de-escalation, and possibly physical intervention. Once a crisis management plan has been put in place, a detailed psychiatric and behavioural assessment needs to be undertaken to investigate whether the boy has a psychiatric problem which may respond to medication—which therefore may be considered to be in the child’s best interest. Should the parents at this point choose not to allow an intervention that is deemed to be in the child’s best interest, legal opinion may be necessary. The behavioural assessment should investigate the appropriateness of the setting in which the behaviour occurs, the range of factors which may trigger the behaviour and the potential rewards and motivators which may sustain the behaviour. Once the reason for the behaviour is clearly understood a suitable intervention may then be possible.

  1. Inexcusable

I recently took up a job as a care worker in a unit for people with challenging behaviour. When I accepted the post six months ago, I was promised that I would receive specific training to help me carry out my duties and role. Despite continuous reminders and requests to my manager for that training, it has not been provided, or even planned. I am told that there are not enough staff to release me, but I feel this is just an excuse. I am worried in case I handle a situation wrongly, as I have no previous experience working with people who have challenging behaviour and I explicitly stated that to my employers when I was offered the job. Could you please advise me what to do?

A.

Specialist facilities for people with challenging behaviour require well-trained staff. When they undertook to provide such a service, your management should have realised that they had an obligation both to their clients and to their staff. In my view their repeated failure to provide training for inexperienced staff is inexcusable. Perhaps the time has come for you to look at other areas of employment.

  1. Extracting a service

My daughter needs cosmetic dental surgery to replace two front teeth. Her medical card will not pay for what I feel she needs urgently. I am a widow on a very limited means and could not afford this financial expense. Is there any assistance available for her dental fees for tooth replacement?

A.

The Dental Hospital at Lincoln Place, Dublin 2, provides some services at reasonable or no cost. Student dentists under supervision do all work, so standards are, I understand, excellent. I suggest you contact them, in the hope that they may be able to help you.

Q.                  Able to work                                       

I am the mother of a 20-year-old man who has Down Syndrome. I have recently found out quite a lot about supported employment, and I am keen that my son should have access to it. I do not understand when the service my son attends tells me that they have assessed him and have found him unsuitable for supported employment.

A.

You are absolutely correct. The service is wrong when it claims it has deemed your son unsuitable for supported employment. A key feature of supported employment is that it assesses a person to figure out the supports he/she will need to work in a real job. Any assessment is only about determining the nature and range of supports that your son will need to hold down a real job. Persist in advocating for your son’s right to support in finding a job.

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